MEDICARE: EDWIN E KASHA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	01032814	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	020007857	OTHER	IN	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000108102	OTHER	KY	ANTHEM PREFERRED ACCESS
2	000000526765	OTHER	IN	ANTHEM
4	35-1738788	OTHER	IN	FEDERAL TAX ID

General Provider Information

NPI Number	:	1932108503
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWIN E KASHA M.D.

Provider Business Mailing Address
First Line	:	PO BOX 15415
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47716-0415
Country	:	US
Telephone Number	:	812-477-9495
Fax Number	:	812-477-0134

Provider Business Practice Location Address
First Line	:	999 S KENMORE DR
Second Line	:	SUITE A
City	:	EVANSVILLE
State	:	IN
Zip	:	47714-7514
Country	:	US
Telephone Number	:	812-477-9495
Fax Number	:	812-477-0134

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	05/09/2008

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Directions to “ EDWIN E KASHA M.D.” Practice Location

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